Duodenal switch (often referred to as “the switch”) is a type of weight-loss surgery typically reserved for obese people who’ve tried unsuccessfully to get their weight under control—sometimes even by having other types of bariatric surgery. Also called bilio-pancreatic diversion with duodenal switch (BPD/DS), the procedure reduces the size of your stomach and reroutes food directly to the distal part of the small intestine so that your body absorbs less of it.
Gastric bypass surgery, the most popular weight-loss surgery, works similarly, but duodenal switch surgery reduces significantly the amount of food that’s absorbed, resulting in more weight loss. Patients routinely lose 100–200 pounds after gastric bypass, while duodenal switch helps them lose even more (typically, 80–100% of their excess weight over about nine months). Because of this, the duodenal switch can help address obesity-related health problems like diabetes and the risk of heart disease, adding years to your life expectancy.
The duodenal switch requires more skill from the surgeon and medical staff than in a gastric bypass surgery, and not all surgeons recommend it because they believe it comes with a higher surgical risk. However, “this isn’t 100% true,” says Dr. Alejandro Lopez, a bariatric surgeon in Tijuana, Mexico. “The surgical risk, in a good weight-loss surgery center, is practically the same as in a gastric bypass.”
As a result, duodenal switch surgery appears to be becoming more popular. “In our practice, more than 30% of all patients we treat get a duodenal switch, which is a great increase from 20 years ago,” says Dr. Gilberto Ungson, a bariatric surgeon in Mexicali, Mexico. “More surgeons are now offering it, and patients are more informed and committed to working with their surgeon to lose weight in a healthy way.”Â
“Duodenal switch causes the most weight loss, with the lowest risk of weight regain and the highest resolution of medical problems of any weight-loss surgery,” says Dr. Jay Roberts, a bariatric surgeon in Fort Worth, Texas.
Dr. Nicole Basa, a bariatric surgeon in Austin, answers this RealSelf member's top questions about weight loss surgery options, including whether it's Worth It.
Pros
Cons
If your health insurance covers bariatric surgery, it may also cover at least part of this procedure. If a duodenal switch is being performed because a gastric bypass was unsuccessful, insurance will often cover the initial surgery but not this revision procedure. Check with your plan provider to see what it will cover.
The ideal candidate for a duodenal switch is:
The procedure is not for everyone. After the surgery, you’ll need to adhere to a very strict vitamin and mineral regimen for the rest of your life, to prevent malnutrition. “It’s important to have access to a nutritionist or medical support as well as to good-quality food and supplements, to avoid developing nutritional complications,” says Dr. Lopez.Â
The switch is also a poor fit for patients with certain health concerns. Patients with severe acid reflux (heartburn) and esophageal or gastric motility problems like achalasia or gastroparesis are not good candidates for duodenal switch surgery, which may worsen reflux in up to 20% of patients; they would be better candidates for gastric bypass surgery.
A qualified weight-loss surgeon can assess whether you’re a good candidate.
The surgery is performed in either a hospital or surgery center, under general anesthesia, as either open surgery (requiring an large incision in your abdomen) or laparoscopically (with five really small incisions).
The operation is performed in two steps.
The switch can be performed in two stages, with the intestinal bypass portion performed up to a year later.Â
By having food empty directly into the last segment of the small intestine, bile from the liver and digestive juices from the pancreas process food lower in the body, giving them less time to pull out calories. The procedure also lowers the overall absorption of fat, so patients absorb only about 20% of the fat they consume.Â
Unlike in a gastric bypass surgery, duodenal switch surgery conserves the pyloric valve, which regulates the release of stomach contents into the small intestine. Leaving this valve intact means that people with a duodenal switch don’t experience dumping syndrome, which happens when your stomach empties its contents faster than normal, causing symptoms like nausea and abdominal cramping.Â
“Patients with the duodenal switch experience two to three bowel movements per day,” says Dr. Ricardo Bonnor, a general surgeon in Houston. “Sometimes the frequency of bowel movements requires revision surgery."
You’ll spend two days recovering in the hospital so you can be monitored. Some discomfort is common, and you’ll be given medication to control the pain. Your surgeon will perform a number of different tests, to check for leaks (perforations in the stomach or bowel) and make sure everything is working properly before you head home.Â
Your surgeon will also give you post-op dietary instructions. You’ll likely be on a liquid diet for a few weeks after surgery, and over time, you’ll start to eat soft foods and then solid foods. The remaining stomach is much larger after duodenal switch surgery than with gastric bypass, and this allows for larger meals. Still, eating too much or too fast may cause stomach cramps or vomiting. You’ll also be directed to take nutritional supplements.
You can resume regular activities in five to seven days, but avoid heavy lifting for six weeks.Â
RealSelf Tip: “Close monitoring after being discharged from the hospital is very important, so be sure to follow up regularly with your surgeon or other healthcare provider,” says Dr. Lopez.
Patients can expect a loss of around 85–95% of excess weight in the first two years, says Dr. Lopez. “Around 80–90% of patients keep their new weight in the long term—10 or more years after surgery,” especially if they've also made healthy lifestyle changes.
Weight loss is usually rapid in the first year, with most patients losing up to 70% of their excess body weight within 12 months. RealSelf members have reported losing 40 pounds the first month after surgery and 100 pounds after six months as well as losing and maintaining a 135-pound weight loss for two and half years. Â
Once weight loss starts, health problems like type 2 diabetes or high blood pressure that were directly caused by excess weight often resolve.
It’s important to be prepared for the excess skin that major weight loss can leave you with. Such was the case with one RealSelf member who weighed 400 pounds and went from a size 28 to a 12/14 after duodenal switch surgery. “My once taut, plump bits are now soft, saggy bits,” she reports. “If you’re doing this for vanity, this may be an issue for you and you may need plastic surgery."
This surgery is generally safe when it’s performed by an experienced, board-certified surgeon. However, like all major surgery, bariatric surgery has numerous possible risks, including infection, adverse effects of anesthesia, excessive bleeding, blood clots, difficulty breathing, and gastrointestinal (GI) leakage. GI leaks, one of the most feared complications, occur in less than 2% to 6% of cases. Rarely (in 0.5% of cases), complications from the surgery can be fatal. Â
Be sure to talk with your doctor and weigh these risks against those that come with chronic obesity, which has about a 5% mortality rate.Â
Like all bariatric surgery, duodenal switch alters the gastrointestinal tract, so your body won’t absorb as much protein or as many essential vitamins (like A, D, E, and K) and minerals (like calcium and iron). As a result, patients are at much higher risk for diseases like anemia, osteoporosis, and protein malnutrition. You’ll need to take supplements every day, without missing a single day, to avoid malnutrition. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), health problems due to deficiencies usually occur in patients who don’t regularly follow up with their surgeon to establish healthy nutrient levels.
Many obese patients are already nutritionally deficient prior to surgery, so a pre-surgery nutritional assessment and correction of deficiencies is required.Â
RealSelf Tip: “The duodenal switch is a very effective surgery—but you need to have it done by a surgeon who has ample experience and performs it frequently, to reduce your surgery risks and optimize your results,” says Dr. Ungson.
Yes. However, according to the ASMBS, it’s recommended that you wait 12–18 months after surgery before getting pregnant, to avoid complications. Most women are more fertile after surgery, so be sure to use protection during intercourse after bariatric surgery.Â
As a bonus, kids born after their mother’s surgery are less at risk of being affected by obesity later, due to activation of certain genes during fetal growth. There’s also less risk of needing a C-section.
Updated August 14, 2023